Voices from suicide survivors – insights for future research agenda

Abstract

Background: Bereavement is a bewildered experience, which has adverse effects on the physical, psychological, mental and social well-being of bereaved persons. Suicide survivors, who lost their loved ones through suicide deaths, are facing extra challenges shaped by the unique characteristics of suicide deaths, the self-inflicted deaths with taboo attached. Compared with the quantity and quality of researches on suicide ideators, attempters and highrisk groups, there are disproportionately fewer on suicide survivors, and are only limited to exploratory level. There is a pressing need to develop research agenda for this special target group, especially for the Chinese population. Objectives: To examine the impact of suicide bereavement on the survivors, and to propose directions for future research on the topic. Methods: Adopting the clinical data mining approach, clinical cases of suicide survivors were reviewed. Common themes were extracted. Results: Three levels of impact were identified. At intrapersonal level, diversified emotional reactions are found. Regret, guilt and shame were distinguished from the common bereavement reactions. The survivors reported reactions to trauma as well. Other themes, that include attitudinal changes and unfinished businesses, were traced. At interpersonal level, there were significant impacts on the bereaved families. Family communications and dynamics change after the suicide. Changes of social network were reported. At transpersonal level, survivors reported their quest for meaning of life after the suicide bereavement. The process was said to be intermingled with the cultural and societal influences. Conclusions: Suicide survivors are facing multi-facet challenges as illustrated. From the voices of clinical suicide survivors, insights for future research agenda are generated. There is a great need for research in this area to guide the development of appropriate services for suicide survivors.

背景：喪親是一個困惑的的經驗，對喪親的人的生理、心理、精神和社會功能都有負面影響。自殺倖存者失去了自殺死去的親人，自殺死亡的獨特情況，社會上對自殺死亡的忌諱，都會造成對倖存者的額外挑戰。與很多關於有自殺念頭者、企圖者和高風險人群的定量核定性研究相比較，自殺倖存者很少受到關注，而且僅處於探索階段。因此，尤其是中國人口，非常有必要研究這部分人群的需要。 目標：（1）探討自殺喪親對倖存者衝擊。（2）為未來研究指出方向。 方法：採用臨床資料的採集方法，復審了自殺倖存者的臨床個案。抽出了常見的問題。 結果：確定了三個層面的影響。在自我層面，出現了多樣化的情緒反應。遺憾、罪疚和自責在常見喪親反應中最常見。倖存者也有精神創傷的反應。追蹤了其他問題，包括態度變化及未完成的生意。在人於人之間關係層面，喪親對家庭有重大影響。在親人自殺之後家庭溝通和互動也有所改變。也發現了社會關係網的改變。在超過人層面，倖存者報告了他們在喪親之後，希望尋找生活的意義。這些過程被認為受文化和社會綜合影響。 結論：如上述所說，自殺倖存者面對多方面的挑戰。從臨床自殺倖存者的聲音，可看到未來的研究方向。非常有必要在該領域進行研究，以引導為自殺倖存者所提供服務的發展。